Intervertebral Implant

ABSTRACT

An intervertebral implant comprises first and second parts having outer surfaces engaging adjacent vertebral surfaces. An insert between these parts provides relative movement therebetween. The first and/or second parts may have engagement means in the form of apertures for engagement with insertion instruments. The first and second parts may nest together, in the absence of the insert, for insertion into the intervertebral space. The boundaries of the implant may form a working space which would include insertion instruments therein. A detent and detent recess may be provided for engagement of the insert and one of said first and second parts.

This application is a continuation of U.S. application Ser. No. 10/018,402, now pending.

BACKGROUND OF THE INVENTION

The invention relates to an intervertebral implant, having an upper part that has a support face for a vertebra and a lower part that has a support face for an adjacent vertebra, on each of which parts engagement elements, which are accessible from one side of the intervertebral implant, for a manipulation instrument are disposed, in order to minimize the structural height of the intervertebral implant upon insertion into an intervertebral space.

One such intervertebral implant is known for instance from U.S. Pat. No. 5,314,477. This intervertebral implant is used to replace a disk removed from the intervertebral space, and accordingly the intervertebral implant must have a relatively low structural height, since it has to fit into the gap between vertebrae. This is particularly difficult if an additional pivot insert is also embedded between the upper part and the lower part, as is the case in the known intervertebral implant of U.S. Pat. No. 5,314,477.

But even in two-piece intervertebral implants, difficulties also arise, especially if the implants also have pins and other protrusions on their support faces that are intended for anchoring the intervertebral implant in the bone. Often, these parts can be inserted only by widening the intervertebral space greatly. Not only is this difficult, but it also presents the risk of injuries.

Since the intervertebral space has a relatively low height, it is also difficult for engagement elements that a manipulation instrument can engage to be secured to both parts of the intervertebral implant. It is conventional to have such manipulation instruments engage the upper part and the lower part separately, for instance by means of pins that are inserted into bores on the upper part and lower part, so that with the manipulation instrument, the two parts of the intervertebral implant can be inserted into the intervertebral space and can optionally also be varied in terms of their spacing from one another, thereby allowing a certain spreading open of the intervertebral space. In this respect, reference is made to the pincerlike manipulation instrument of U.S. Pat. No. 5,314,477.

Because of the strong forces, it is necessary to provide a certain structural height for the engagement elements; for instance, the receiving bores must have a certain diameter. This dictates a minimum structural height for the upper part and for the lower part, and in conventional intervertebral implants, the structural heights of the upper part and lower part are thus added together, so that even if the upper and lower parts rest directly on one another, a relatively great structural height of the intervertebral implant is still unavoidable.

SUMMARY OF THE INVENTION

It is the object of the invention to embody an intervertebral implant of this generic type in such a way that the minimum structural height is reduced, to make it easier to insert the intervertebral implant into the intervertebral space.

In an intervertebral implant of the type described at the outset, this object is attained in accordance with the invention in that it is proposed that the upper part and lower part each have protrusions and recesses aimed at the respectively other part, which are offset laterally from one another in such a way that when the upper part has been brought close to the lower part they mesh with one another; and that the engagement elements on the upper part and on the lower part are each disposed in protrusions of these parts in such a way that the engagement elements of the upper part and lower part are located side by side and at least partly overlap in the direction of the height of the intervertebral implant.

In such an embodiment, a minimal structural height of the two intervertebral implant parts resting on one another can be attained, since the engagement elements, which cannot fall below a minimal structural height, are each disposed in protrusions of the upper part and lower part, or in other words in the parts of the upper part and lower part that have the greatest structural height. These regions of great structural height are embodied as protrusions, next to which are respective recesses, into which the protrusions of the respectively other part can dip. As a result, on the one hand, the engagement elements for the manipulation instruments are located side by side, and on the other, they can at least partly overlap, so that the total structural height of the parts resting on one another of the intervertebral implant can be reduced markedly compared to conventional intervertebral implants. The result is accordingly an internested arrangement of the upper and lower parts, with maximal exploitation of the available material height.

It is favorable if the engagement elements are insertion openings for pinlike retaining elements of a manipulation instrument; because of the described construction, these insertion openings can have a relatively large diameter and can thus receive strong retaining pins, and nevertheless a relatively low structural height of the intervertebral implant with parts resting directly on one another is obtained.

It is advantageous if the insertion openings extend substantially parallel to the support faces; once again, this prevents an increase in the structural height of the intervertebral implant parts.

In a preferred embodiment, it is provided that the lower part has a central indentation, opposite the lower support face, which indentation is surrounded by a U-shaped edge. Thus with the lower part and upper part resting directly on one another, the indentation serves to receive a protrusion on the upper part.

It is advantageous if the upper part has a central protrusion that fits substantially in complimentary fashion into the indentation; that is, the total volume of the indentation is utilized for the protrusion.

It is also advantageous if the engagement elements of the lower part are disposed on the two ends of the U-shaped edge, or in other words are located on the outside.

Conversely, the engagement elements of the upper part can be disposed on the central protrusion of the upper part, or in other words are located farther inward than the engagement elements of the upper part.

In particular, the engagement elements of the upper part can be disposed near the lateral edges of the central protrusion, so that for the upper part as well, the spacing of the engagement elements can be selected to be relatively great; as a result, both the upper part and the lower part can be reliably secured against skewing.

It should already be noted here that the words “lower part” and “upper part” do not necessarily say anything about the installed position of the intervertebral implant in the spinal column; the part called the “lower part” could in fact be above in the spinal column. Therefore, these parts may also be referred to as first and second parts having outer and inner surfaces. What is essential is merely that the upper part and lower part define the intervertebral implant on opposite sides of the implant.

It is especially advantageous if the upper part and/or the lower part is embodied in substantially platelike fashion; these parts naturally, in accordance with the design of the invention, have protrusions and recesses that are oriented toward the respectively other part. The platelike embodiment, however, leads as a whole to a very low structural height of the intervertebral implant.

In a preferred embodiment, the lower part and the upper part each have a respective receptacle for a pivot insert. This pivot insert, which is placed between the upper part and lower part after the insertion of the intervertebral implant, supports the upper part and lower part against one another; it takes on a resilient function, for instance, and furthermore leads to a certain pivotability of the two parts of an intervertebral implant relative to one another, so that a pivotability of the adjacent vertebra is thus attainable as well.

In particular, it is advantageous if the pivot insert has at least one spherical support face, which engages the correspondingly spherically shaped receptacle.

It is favorable if the spherical receptacle is disposed in the central protrusion of the upper part.

It is also advantageous if the central indentation of the lower part forms the receptacle for the pivot insert.

According to a preferred embodiment of the invention, it is provided that the pivot insert can be inserted from the side into the receptacle, which has the engagement elements for a manipulation instrument. This is the side from which the upper part and lower part are introduced into the intervertebral space, and it is also from this side that the pivot insert can then be thrust between the already-inserted parts of the intervertebral implant.

It is favorable if the pivot insert is insertable into the receptacle along a guide.

In that the insert as well is preferably embodied substantially in platelike fashion.

An especially favorable design is obtained if the insert substantially completely fills up the central receptacle and with its spherical support face protrudes from the receptacle.

BRIEF DESCRIPTION OF THE DRAWINGS

The ensuing description of preferred embodiments of the invention serves in conjunction with the drawing to provide further explanation. Shown are:

FIG. 1: a perspective exploded view of an intervertebral implant with an upper part, a lower part, and a pivot insert that can be inserted between them;

FIG. 2: a perspective exploded view of the upper part and the lower part of the intervertebral implant, without an inserted pivot insert;

FIG. 3: a view similar to FIG. 2 with the pivot insert inserted into the lower part;

FIG. 4: a perspective view of the upper part and the lower part of the intervertebral implant with maximum mutual proximity;

FIG. 5: a front view of the intervertebral implant of FIG. 4;

FIG. 6: a perspective view of the intervertebral implant with the pivot insert inserted; and

FIG. 7: a cross-sectional view of the intervertebral implant of FIG. 6.

DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS

The intervertebral implant 1 shown in the drawing includes three parts, namely a platelike upper part 2, a platelike lower part 3, and a substantially platelike pivot insert 4.

The upper part 2 is embodied flat on its top, thus creating a support face 5, on which various kinds of protrusions 6, 7 are disposed which serve the purpose of anchoring the upper part 2 in a vertebra that rests, with its end face toward an intervertebral space, on the support face 5.

The upper part 2 is substantially rectangular in cross section; in the exemplary embodiment shown, a longitudinal edge 8 curves outward.

On the two short sides of this rectangle, the thickness of the platelike upper part 2 is less than in the central region, so that along the short sides of the upper part 2, downward-pointing recesses 9 each extending parallel to these edges are formed that are open toward the outside. The central region of the upper part 2 is located between the two recesses 9 and thus has a greater thickness or height and thus forms a downward-pointing protrusion 10 embodied between the two recesses 9. This protrusion is defined by an underside 11, which extends substantially parallel to the support face 5 and in which there is a spherical indentation 12, which forms a bearing plate for the pivot insert 4.

The lower part 3 of the intervertebral implant 1 is also platelike in embodiment and on its underside has a flat support face 13 with protrusions 14 and 15, which correspond to the protrusions 6 and 7 of the support face 5. On the side remote from the support face 13, the thickness of the lower part 3 is less in the central region than in an outer region. This outer region of greater thickness has the form of a U, with two parallel legs 16, 17, which extend parallel to the short edges of the lower part 3, which in cross section is embodied similarly to the upper part 2, and with a crosspiece 18 that connects the two legs 16 and 17 on one end. The region enclosed by the legs 16 and 17 and the crosspiece 18 forms a central indentation 19, whose area is substantially equivalent to the area of the central protrusion 10 of the upper part 2, while the disposition and length of the legs 16 and 17 correspond essentially to the disposition and length of the recesses 9 on the upper part 2. As a result, it is possible to place the upper 2 and lower part 3 on one another in such a way that the central protrusion 10 of the upper 2 dips into the central indentation 19, while the legs 16 and 17 of the lower part 3 dip into the recesses 9 of the upper part 2 (FIG. 4); in this position, the upper part 2 and lower part 3 have maximum proximity to one another and a minimal structural height.

The dimensions are selected such that the various recesses are essentially filled completely by the protrusions dipping into them.

Blind bores 20 and 21 are machined into the two legs 16 and 17 of the lower part 3, extending parallel to these legs 16, 17 from their free ends; the diameter of these bores is relatively great in proportion to the height of the legs 16, 17, and this diameter is in fact greater than the thickness or height of the lower part 3 in the region of the central indentation 19.

Blind bores 22 and 23, which extend parallel to the blind bores 20 and 21 in the lower part 3, are machined into the central protrusion 10 of the upper part 2, in the vicinity of its side edges. These blind bores 22 and 23 again have a relatively great diameter, which corresponds to a substantial portion of the height of the protrusion 10 and is greater than the thickness of the upper part 2 in the region of the recesses 9.

When the upper part 2 and lower part 3 rest tightly against one another in the manner described, the blind bores 20 and 21 of the lower part 3 and the blind bores 22 and 23 of the upper part 2 overlap at least partly in the direction of the height of the intervertebral implant 1, as is clearly shown in FIGS. 4 and 5.

The blind bores 20, 21, 22 and 23 serve as receptacles for pinlike extensions of a manipulation instrument, not shown in the drawing, and thus form engagement elements for this manipulation instrument, which in this way separately engages the upper part 2 and the lower part 3. With this manipulation instrument, it is possible to introduce the upper part 2 and the lower part 3 of the intervertebral implant 1 into an intervertebral space; the very low structural height of the intervertebral implant 1 facilitates this introduction, which can be done essentially without major widening of the intervertebral space.

After the introduction of the upper part 2 and lower part 3 in this way, the two parts of the intervertebral implant 1 can be spread apart; that is, their spacing is increased, for instance with the aid of the manipulation instrument that is holding the upper 2 and the lower part 3.

In this spread-open position of the upper part 2 and lower part 3, it is possible to thrust the pivot insert 4 between the upper part 2 and the lower part 3.

This pivot insert is constructed essentially in the shape of a plate, which has a flat underside 24 and a spherically upward-curved top side 25. The outer dimensions of the platelike pivot insert correspond to those of the central indentation 19 in the lower part 3, so that the pivot insert 4 can be thrust into this indentation, filling it up, specifically from the side toward which the blind bores 20, 21, 22, 23 open. Guide strips 26 on the side edges of the pivot insert 4 engage corresponding guide grooves 27 in the legs 16, 17, so that an insertion guide for the pivot insert 4 is formed that fixes it in the lower part 3 after its insertion. The inserted pivot insert 4, after insertion, fills up the indentation 19 and protrudes with its spherically curved top side 25 upward past the top side of the lower part 3; the spherical top side 25 dips in complimentary fashion into the spherically curved indentation 12 on the underside of the protrusion 10, where with the upper part 2 it forms a ball joint, which enables a certain pivotability of the upper part 2 relative to the lower part 3 (FIG. 7).

The pivot insert 4 can have a detent protrusion 28 on its flat underside 24; when the pivot insert 4 is inserted into the lower part 3, this protrusion locks elastically into a detent recess 29 that is located on the bottom of the indentation 19; as a result, the pivot insert 4 is also fixed in the insertion direction in the indentation 19.

The upper part 2 and lower part 3 are preferably made of physiologically safe metal, such as titanium, while the pivot insert 4 preferably comprises a likewise physiologically safe plastic material, such as polyethylene. These support faces 5 and 13 can be embodied in an especially bone-compatible way; for instance, this surface can be roughened by a coating, so that optimal anchoring to the adjacent bone material is obtained.

The invention may also be described as follows, which description is the full equivalent of the preceding discussion. An upper part 2 has an upper surface 5 for engaging a vertebrae and a lower surface which comprises a downward pointing protrusion 10 between side recesses 9 and a rounded portion, preferably in the form of a concave spherical indentation 12. A lower part 3 has a lower surface 13 for engaging a vertebrae. A pivot insert 4, when joined to the lower part 3, as shown for example in FIG. 3, provides a convex upper surface portion 25, preferably spherical, in operational engagement with the rounded portion 12 of the upper part.

The lower part 3 and pivot insert 4 may, taken together, be described as a lower part formed in two pieces, namely the elements 3 and 4, wherein the element 3 may be referred to as a lower piece and the element 4 may be referred to as an upper piece.

The upper and lower parts include on their upper surface and lower surface, respectively, protrusions 7 and 14 which may also be referred to as anchors, which anchor the upper and lower parts, respectively, into the adjacent vertebrae that form the intervertebral space and rest against the respective upper and lower surfaces.

As shown in the figures, the anchors 6 and 14 each have a zigzag edge which comprise teeth. As best shown in FIG. 7, anchor 6 is greater in height than the remainder of the upper part 2, i.e., from surface 5 to the bottom of protrusion 10. Similarly, anchor 14 is greater in height than the remainder of the lower part 3, i.e., from lower surface 13 to the top of walls 16, 17 and 18. As also shown in the figures, in the preferred embodiment, the length of the anchors 6 and 14, i.e., in the direction from the anterior to the posterior thereof, is greater than one half of the overall dimension of its respective part from its anterior to its posterior, passing through that anchor.

The lower part comprises three walls including parallel side walls 16 and 17 and a rear wall 18. These walls form between them a central indentation 19 which comprises a recess with a generally flat surface. The fourth side of the recess is open. The pivot insert 4 has a detent 28 that snap-fits into a detent recess 29 formed in the generally flat surface of recess 19.

As best shown in FIGS. 2, 4 and 5, in the absence of pivot insert 4, the protrusion 10 of upper part 2 can fit down between walls 16, 17 and 18 of the lower part 2. This fitting of protrusion 10 within the recess 19, surrounded by walls 16, 17 and 18 may be referred to as “nesting” since the protrusion 10 essentially “nests” within recess 19. With the upper and lower parts in this nested condition, as shown in FIGS. 4 and 5, the combined height of the upper and lower parts 2 and 3, i.e., the height from surface 13 to surface 5, is less than the total additive height of the upper and lower parts, taken separately, i.e., less than the total of the height from surface 13 to the top of walls 16, 17 and 18 plus the height from surface 5 to the bottom of protrusion 10.

To reach its final destination within an intervertebral space, the implant must of course be moved along a path from outside of the patient, into the patient, and then into the intervertebral space. In the illustrated embodiment, as described above, instruments would engage apertures 20, 21, 22 and 23 to move the implant along a path. The anchors 6 and 14 are parallel to this path. As a point of reference, lateral planes parallel to the direction of this path pass through opposed side surfaces of the parts. Thus, in the illustrated embodiment, the path would be parallel to the front to rear (anterior to posterior) direction, wherein, during insertion, the rear (posterior) of the implant would constitute the lead end and the front (anterior) thereof would constitute the trailing end.

Although the invention has been described in detail with respect to preferred embodiments thereof, it will be apparent that the invention is capable of numerous modifications and variations, apparent to those skilled in the art, without departing from the spirit and scope of the invention. 

1. An intervertebral implant comprising: a first part which has an outer surface for engaging a vertebrae and an inner surface which has a rounded portion, a second part which has an outer surface for engaging a vertebrae and an inner surface having a recess with an opening on one side, and an insert having a base portion which is shaped to enter the said opening to be engaged in said recess, and a raised portion which is smaller in area, transversely, than the base portion and which extends from the base portion to a rounded portion which mates with the rounded portion of the first part to allow relative movement of the first part and the second part.
 2. An intervertebral implant according to claim 1, the rounded portion of the first part being concave and the rounded portion of the insert being convex.
 3. An intervertebral implant according to claim 2, wherein the rounded concave portion and rounded convex portion are spherical.
 4. An intervertebral implant according to claim 1, wherein the inner surface of the second part comprises a pair of opposed side walls forming said recess therebetween, and the opening is located between said side walls.
 5. An intervertebral implant according to claim 4, wherein the side walls and the base portion of the insert comprise interengaging flange and groove connections.
 6. An intervertebral implant according to claim 1, wherein at least one of the first part and second part have, on its end which includes the opening, engagement means for engaging an instrument for insertion of the first and second parts into an intervertebral space between adjacent vertebrae.
 7. An intervertebral implant according to claim 6, wherein the engagement means comprise apertures.
 8. An intervertebral implant according to claim 1, the first part having an inwardly directed protrusion which includes its rounded portion, said protrusion, in the absence of the insert, being nestable in the recess of the first part, such that the total height of the first and second parts, in the nested condition, without the insert, is less than the additive total height of the first and second parts, taken separately.
 9. An intervertebral implant according to claim 1, wherein the recess in the first part includes a generally flat surface bounded by three walls including two opposed side walls and an end wall located at an end opposite from said opening.
 10. An intervertebral implant according to claim 1, the first and second parts being generally rectangular.
 11. An intervertebral implant comprising: a first part having an outer surface for engaging a vertebrae and a curved inner surface, a second part having an outer surface for engaging a vertebrae and an insert receiving inner surface, an insert having a curved surface which engages the curved inner surface of the upper part for movement relative thereto and engaged with the inner surface of the lower part, the lower part having an opening to receive the insert by transverse movement of the insert into engagement with the inner surface of the lower part, and wherein at least one of the first part and second part have, at the end thereof where said opening is located, engagement means for engaging an instrument for inserting the first and second parts into an intervertebral space between adjacent vertebrae.
 12. An intervertebral implant according to claim 11, wherein the engagement means comprises instrument receiving apertures.
 13. An intervertebral implant according to claim 12, wherein the second part comprises opposed side walls and the opening is located between the opposed side walls, and the apertures are located in the inwardly extending protrusion of the first part and in the side walls of the second part.
 14. An intervertebral implant according to claim 13, said first part protrusion, in the absence of the insert, being nestable between the opposed side walls of the second part, such that the total height of the first and second parts, in the nested condition, without the insert, is less than the additive total height of the first and second parts, taken separately.
 15. An intervertebral implant according to claim 11, the curved surface of the insert being spherical, and the curved inner surface of the first part being spherical.
 16. An intervertebral implant according to claim 15, wherein the curved surface of the insert is convex and the curved inner surface of the first part is concave.
 17. An intervertebral implant according to claim 11, wherein the first and second parts are generally rectangular.
 18. An intervertebral implant comprising: a generally rectangular first part having an outer surface for engaging a vertebrae and a curved inner surface for engaging an insert for movement relative thereto, a generally rectangular second part having an outer surface for engaging a vertebrae and an inner surface for engaging an insert, the inner surface of the lower part having a recess which includes an opening for receiving an insert transversely therein, the insert having a curved surface and being insertable transversely through said opening into the recess for engagement with the second part and for operative engagement of its curved surface with the curved inner surface of the first part for movement relative thereto.
 19. An intervertebral implant according to claim 18, the second part having opposed side walls and forming the recess therebetween and the opening extending between the side walls.
 20. An intervertebral implant according to claim 19, the insert comprising a generally rectangular base portion secured to said opposed side walls and a raised portion projecting from the base portion and of a smaller area, taken transversely, than the base portion.
 21. An intervertebral implant according to claim 18, including engagement means in at least one of the first or second parts, on the side thereof where the opening is located, for engaging with an instrument for inserting the first and second parts into an intervertebral space between adjacent vertebrae.
 22. An intervertebral implant according to claim 18, the first part having an inward protrusion which includes the curved inner surface, and wherein the first part protrusion, in the absence of the insert, being nestable between the opposed side walls of the second part, such that the total height of the first and second parts, in the nested condition, without the insert, is less than the additive total height of the first and second parts, taken separately.
 23. An intervertebral implant comprising: a first part having an outer surface for engaging a vertebrae and having an inner surface having an inwardly extending protrusion, a second part having a lower surface for engaging a vertebrae and an inner surface formed as a recess which is constructed to receive an insert which, in use, operatively engages the first part, and wherein the protrusion of the first part is nestable in the recess of the second part for insertion of the two parts together into an intervertebral space.
 24. The intervertebral implant according to claim 23, further comprising engagement means in at least one of the first and second parts for engagement with an instrument for inserting the first and second parts into an intervertebral space between adjacent vertebrae.
 25. The intervertebral implant according to claim 23, wherein the recess of the first part is formed by two opposed side walls, and a connecting end wall, an opening along an end opposite from the end wall, and wherein the engagement means comprise apertures in the first and second parts at the ends thereof where the opening is located.
 26. The intervertebral implant according to claim 23, wherein, in the nested condition the total height of the nested first and second parts is less than the additive total height of the first and second parts, taken separately.
 27. The intervertebral implant according to claims 23, further comprising an insert engagable within the recess of the first part, said insert having a raised portion with a convex portion, and wherein the inner surface of the upper part has a concave portion shaped to mate with the convex portion.
 28. The intervertebral implant of claim 23, further comprising engagement apertures formed at least in the protrusion of the first part and in the opposed side walls of the second part for receiving an instrument for inserting the first and second parts into an intervertebral space between adjacent vertebrae, wherein in the nested condition of the first and second parts, the engagement apertures of the upper and lower parts are in line transversely.
 29. The intervertebral implant of claim 23 wherein the first and second parts are generally rectangular.
 30. The intervertebral implant of claim 23, including an insert which fits into the recess in the second part.
 31. The intervertebral implant of claim 23, wherein the recess of the second part comprises a generally flat surface with three walls including two opposite side walls and an end wall and including an opening opposite the end wall.
 32. An intervertebral implant comprising, a first part having an outer surface for engaging a vertebrae and an inner surface for operatively engaging an insert, second part having an outer surface for engaging a vertebrae and an inner surface constructed to hold an insert, and at least one of the first part and second part having engaging means for engaging instruments for insertion of the first part and second part together into an intervertebral space between two adjacent vertebrae, the first part and second part each having a lead end which leads as the implant is inserted in an insert direction into an intervertebral space and a trailing end opposite the lead end, and said engaging means being located on the trailing end of the at least one first and second parts such that said instruments are located in a working space between parallel planes passing through opposed sides of the implant and parallel to the direction of insertion, and the implant having an opening located in the trailing end of the implant and within the working space for allowing insertion of an insert into the space between the first and second parts.
 33. The intervertebral implant according to claim 32, wherein the opening is formed in the trailing end of the second part.
 34. The intervertebral implant according to claim 32, wherein the engaging means comprise apertures in the trailing end of at least one of the first and second parts.
 35. The intervertebral implant according to claim 32, wherein the first part has an inward protrusion which includes the inner surface, the second part having opposed side walls extending parallel to the insertion direction, and the opening being formed between said side walls, said protrusion, in the absence of an insert, being nestable between the opposed side walls of the second part.
 36. The intervertebral implant according to claim 35, wherein the engaging means comprise apertures on the protrusion of the first part and on the side walls of the second part, and wherein in the nested condition the apertures of the first part and the apertures of the second part are in line transversely.
 37. The intervertebral implant according to claim 35, wherein the second part includes a generally flat surface with the two opposed side walls and including an end wall located at an end opposite from said opening.
 38. The intervertebral implant according to claim 32, wherein the first and second parts are generally rectangular.
 39. The intervertebral implant according to claim 32, including an insert which has a raised portion which has a curved portion which mates with a curved portion formed in the inner surface of the first part.
 40. An intervertebral implant comprising: a first part having an outer surface for engaging a vertebrae and having an inner surface, a second part having an outer surface for engaging a vertebrae and an inner surface, an insert having a first surface engaging the inner surface of the first part and a second surface engaging the inner surface of the second part, the inner surface of the second part being constructed to receive said insert, one of the inner surface of the second part and the second surface of the insert including an elongated detent recess extending thereacross, and the other of the inner surface of the second part and the first surface of the insert having an elongated detent, which detent is resiliently engagable in the detent recess as the insert is inserted onto the inner surface of the lower part.
 41. An intervertebral implant according to claim 40, the inner surface of the upper part being curved, and the first surface of the insert being curved to mate with the inner surface of the first part so as to allow relative movement of the first and second parts.
 42. An intervertebral implant according to claim 41, the second part having opposed side walls and an opening in the end between the side walls to allow the insert to move between the opposed side walls.
 43. An intervertebral implant according to claim 42, said detent recess extending across the inner surface of the second part perpendicular to the side walls, and the protrusion located on the insert and also extending perpendicular to the side walls so as to engage the detent recess in the second part.
 44. An intervertebral implant according to claim 42, wherein the insert receiving inner surface of the second part has a back wall perpendicular to the two opposed side walls and an open front for receiving the insert.
 45. An intervertebral implant according to claim 42, wherein the insert includes a generally rectangular base portion which substantially fills the space formed between the opposed side walls.
 46. An intervertebral implant according to claim 41, wherein the first part has an inwardly directed protrusion which includes an inner surface, said protrusion, in the absence of the insert, being nestable between the opposed side walls of the second part, such that the total height of the first and second parts, in the nested condition, without the insert, is less than the additive total height of the first and second parts, taken separately. 